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Concert Pharmaceuticals has announced a second open label clinical trial into a form of its novel oral treatment for Alopecia Areata, CTP-543 is due to start soon.

This will concentrate on a one-a-day 24mg dose of CTP-543 and will compare results to 12mg twice-daily doses, taken by separate, randomized groups over a 24 week period.

Each of the 60 patients taking part across the USA and Canada will have a confirmed diagnosis of hair loss from Alopecia Areata, Alopecia Totalis or Alopecia Universalis.

These are the key forms of the autoimmune disease Alopecia Areata, which presents as patchy hair loss to the scalp only (Alopecia Areata), total baldness of the head, often including a loss of eyelashes, eyebrows and facial hair (Alopecia Totalis), and complete hairlessness from head to toe (Alopecia Universalis).

Pills medication tablets

Whilst not exactly a JAK inhibitor itself – the suite of drugs currently leading the race to produce the first authorised, MHRA-licensed and FDA-cleared treatment for all forms of Alopecia Areata – CTP-543 is a deuterium modified version of the Janus kinase 1 and 2 inhibitor, ruxolitinib (brand name, Jakafi).

Complementary trial

This new trial – which is currently estimated to complete in April 2020 – has been designed to complement Concert’s first open label trial of CTP-543. Findings should help researchers to determine the drug’s optimal dosing, providing the basis of doses to be tested further in additional clinical trials.

The first study, which began in March 2019 and is due to complete later in the year, involves participants receiving oral CTP-543 doses of either 8 mg twice per day or 16 mg once each day, for a total of 24 weeks.

Both trials will compare patients’ baseline and 24 week-mark Severity of Alopecia Tool (SALT) scores in order to determine the drug’s – and dose’s – efficacy.

“Our aim is to optimize the dosing regimen for CTP-543, so that we can best meet the needs of patients with this autoimmune disease for which there are currently no FDA-approved treatments,” said James V. Cassella, Ph.D., Chief Development Officer of Concert Pharmaceuticals, via a company press release.

Interim CTP-543 phase 2 trial results

The most recent update as to how the current CTP-543 trials are going, was provided at the March 2019 American Academy of Dermatology (AAD) Annual Meeting, where promising interim results were disclosed from an ongoing Phase 2 trial.

Concert Pharmaceuticals’ CTP-543 has received Fast Track designation from the FDA, along with two other companies also developing potential hair loss solutions – oral and/or topical – to address mild to severe Alopecia Areata.

food-and-drug-administration-usa-fda

Due to the significant emotional and psychological effects these various forms of sudden hair fall can cause, and the fact no FDA-approved – nor MHRA-licensed – hairloss treatment for these specific conditions yet exists, the FDA is hoping to help speed up the process for developing treatments by working closely with the most promising candidates.

The earliest likely release date for any of these novel hair loss solutions is estimated to be 2021-22.

In the meantime, Alopecia Areata treatment is available for adults with the scalp-only phenotype, and a personalised course can be recommended following a consultation with a hair loss specialist.

Adults with more extensive baldness, or children with any form of Alopecia, are advised to contact their GP or dermatologist as a first port of call. Hair loss charities can also provide invaluable help in the form of free wigs, contacts for suppliers and local or online peer support groups.

However, hopefully, we are now closer than ever to there being a realistic treatment option for those who have lost their hair to conditions as severe as Alopecia Universalis, and would love to have it back again.


The Belgravia Centre

The Belgravia Centre is an organisation specialising in hair growth and hair loss prevention with two clinics and in-house pharmacies in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. View our Hair Loss Success Stories, which includes the world’s largest gallery of hair growth comparison photos and demonstrates the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time to arrange a free consultation.

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It has long been established that stress is one of the key non-genetic influences on hair loss of various kinds.

The autoimmune disorder Alopecia Areata, which causes rounded bald spots, or patchy hairloss to the scalp, to appear suddenly, can often be triggered by a sudden shock or trauma.

Now, scientists investigating the relationship between ‘social stress’ – defined as that caused by particularly stressful life events – and autoimmune diseases have found that gut health may be the missing link.

This work expands on previous studies also suggesting associations between the gut and Alopecia Areata.

Social stress-reactive gut microbiota

The study was written and carried out by researchers at the Azrieli Faculty of Medicine, Bar Ilan University in Safed, Israel, and was published in early May 2019 by the American Society for Microbiology.

stomach gut health

Through a number of mice trials, where a group of mice were subjected to other aggressive mice (providing ‘social stress’) for 10 days, and a control group of mice was not, they demonstrated that “chronic social stress induces virulence-associated transcriptional patterns in the murine gut microbiota”.

Essentially, this means that when we encounter intense stress in our lives, the reaction this causes in our gut may then affect our immune system, leading to some individuals having an increased risk of developing autoimmune disorders, including the various forms of Alopecia Areata, including Alopecia Totalis and Alopecia Universalis.

You can find out more about the methodology and in-depth report of the team’s finding in their paper, entitled Social-Stress-Responsive Microbiota Induces Stimulation of Self-Reactive Effector T Helper Cells.

These findings may show that the type of stress that can trigger autoimmune disorders does not need to be sudden, for instance following an accident or a bereavement, and may also be due to prolonged periods of high stress levels.

Furthermore, they are food for thought for researchers developing potential treatments for these conditions; in the future it may be that we see drugs that target the gut in order to treat Alopecia Areata.

Current treatment options

Current Alopecia Areata treatment options tend to only be of significant potential benefit for people with the scalp-only form.

Those with the more extensive forms – Alopecia Totalis and Universalis – which cause baldness of the entire head, including facial hair, or from head to toe, respectively – have limited options at present.

However, over the past few years previously unseen levels of research and development have been on-going and it is hoped that – whilst a cure for Alopecia Areata remains elusive, new treatment options for all forms of the disorder will soon be ready for prescription.

The most promising area of development at present is that of JAK inhibition, with various large pharmaceutical companies, including Pfizer and Aclaris Therapeutics, racing to be the first to bring their Alopecia Areata medication to market. It is estimated that the earliest these treatments – topical and/or oral – would be made available by is 2021.

For now, adults with the scalp only phenotype can get hair loss advice and treatment recommendations from a specialist hair loss clinic, whilst children under 16 with any form and adults with more extensive iterations should consult their GP or dermatologist.


Circ - Belgravia Centre Hair Loss Clinics LondonThe Belgravia Centre

The Belgravia Centre is an organisation specialising in hair growth and hair loss prevention with two clinics and in-house pharmacies in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. View our Hair Loss Success Stories, which includes the world’s largest gallery of hair growth comparison photos and demonstrates the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time to arrange a free consultation.

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Researchers are still trying to prove whether or not platelet rich plasma therapy (PRP) is an effective way to treat various forms of hair loss, either on its own or as an adjunct to clinically-proven treatments.

The latest findings come from the Department of Dermatology at Chengalpattu Medical College in Tamil Nadu, India, where a team has been investigating PRP as a treatment for Alopecia Areata.

PRP Research Italy Feb 2017
An example of PRP being administered for hair loss during a trial in Italy (February 2017)

This is an autoimmune disorder which can cause various amounts of baldness to the scalp and other hair-bearing areas, from mild (patchy hair loss of the scalp only – Alopecia Areata) to complete loss of all hair from head to toe (Alopecia Universalis).

This study report, published in the May 2019 International Journal of Research in Dermatology, does not specify which types of autoimmune alopecia it concentrated on, but – from the progress photos included in the study – it would appear to be the scalp-only form.

Small scale trial

The Chengalpattu team recruited a total of 20 participants – 16 men and 4 women – for the study, making it particularly small in scale.

Each participant took part in four sessions, where was administered PRP injections directly into the areas of the scalp where hair loss was present, every 28 days for a total of 6 months. A follow-up was also carried out at the 12 month mark, 6 months after this PRP treatment had ended.

Of the 20 patients, 13 (65%) are said to have “responded well to treatment”, 3 (15%) reported a “moderate response” and 4 (20%) “showed no response”. Two (10%) of the total group also experienced a relapse at the end of the study.

Debatable conclusion

The study’s corresponding author, Dr. Kamalanathan Nallu and their team concluded from these results that “PRP was found to be an effective treatment modality for alopecia areata”.

This is a debatable statement given the size of the study and the fact that Alopecia Areata is an erratic condition whereby spontaneous hair regrowth may resume naturally, especially within the first 12 months of developing the scalp-only iteration.

As Belgravia Superintendent Pharmacist, Christina Chikaher advises, “Whilst PRP may yet be proven to have benefits for those with Alopecia Areata, this study is too limited to show this outright.

Larger, wider-ranging trials would be needed before it could reasonably be claimed that PRP is – or is not – an effective method of treating alopecia.

However, it is certainly an increasingly popular approach to addressing a number of non-scarring hair loss conditions, despite any firm, reliable scientific proof of its role in hair growth, and definitely warrants further long-term investigation.”

There are many drugs in the advanced stages of clinical trials that appear promising as potential treatments for Alopecia Areata, Totalis and Universalis, most notably those based on JAK inhibitors.

For now though, any adults with patchy hair loss to the scalp only may be offered Alopecia Areata treatment at a specialist hair loss clinic, whilst those with the more severe forms, and children with any phenotype, are advised to consult their GP as a first port of call.

Further information about dealing with the condition and helpful resources, such as where to obtain free real-hair wigs and details of local peer support groups, can also be found via dedicated hair loss charities, such as Alopecia UK and the Little Princess Trust/Hero by LPT.


The Belgravia Centre

The Belgravia Centre is an organisation specialising in hair growth and hair loss prevention with two clinics and in-house pharmacies in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. View our Hair Loss Success Stories, which includes the world’s largest gallery of hair growth comparison photos and demonstrates the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time to arrange a free consultation.

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Hair loss is not always genetic; there are many reasons unexpected hair fall may happen, one of which is due to illness.

This subject has been in the news recently after Sarah Hyland, star of the long-running US comedy series Modern Family, spoke to the Refinery29 website about the hair loss she experienced following on-going issues with endometriosis and kidney dysplasia, as well as two kidney transplants. She also noted how her previously straight hair turned curly when it grew back.

Here Belgravia hair loss specialists explain the various reasons behind shedding following illness or surgery and some of the quirks that can occur when hair regrows.

Stress placed on body

hospital medical illness doctor health medication

“Various illnesses and medical conditions can cause shedding as a side effect of the stress they place on the body; this is because the body diverts its resources away from ‘non-essential’ functions, such as the hair growth cycle, so it can protect critical organs such as the heart and lungs, whilst fighting the health issue,” advises Senior Hair Loss Specialist, Leonora Doclis. “The emotional stress which can accompany illness can also be a factor.

This can then causes a disturbance to normal hair growth, which results in diffuse hair loss from all over the scalp, presenting around three months later. This is known as Telogen Effluvium when it lasts for up to six months but, in more persistent cases – perhaps where an illness is on-going or longer-term – this can last more than six months and is classed as Chronic Telogen Effluvium, also known as Diffuse Thinning.

Although these are temporary hair loss conditions, they may be quite distressing as they can appear to come on suddenly with up to 30 per cent – sometimes more – of the hair being affected at once.”

These types of hair thinning can also occur following surgery. As Doclis explains, “When someone undergoes major surgery, this can also cause a ‘shock to the system’, which again disrupts the hair growth cycle and can spark the same kinds of hair loss. Alternatively – or additionally – it may also cause sudden bald spots or patches from the autoimmune disorder Alopecia Areata to appear, though normal hair growth often returns naturally within 12 months in these instances.”

Medication can also cause hair to shed

Another illness-related issue that can cause temporary shedding is prescription medication used to treat the underlying health concern.

Belgravia Superintendent Pharmacist, Christina Chikaher, says “Many drugs list hair loss as a possible side effect on the patient information leaflet which accompanies the medication.

This is a form of Telogen Effluvium that occurs within approximately three months of starting the treatment, and should right itself naturally within six months, once the body has adjusted to the new drugs.

The most prominent exception to this being cancer drugs and therapies; it generally takes up to 12 months from the last session for hair loss from chemotherapy to regrow naturally – perhaps less if a cold cap was worn during treatment and the shedding was relatively moderate – though radiotherapy can result in permanent baldness as it destroys hair follicles as well as cancer cells.”

Areas of scalp affected by genetic hair loss and telogen effluvium temporary permanent baldness diagram

May worsen pattern hair loss

Although Telogen Effluvium and Chronic Telogen Effluvium are both temporary, they are linked to permanent hair loss conditions.

“They can exacerbate existing cases of Male Pattern Baldness or Female Pattern Hair Loss, or even trigger the premature onset of these permanent, hereditary conditions where the individual has an existing genetic predisposition,” notes Belgravia Hair Specialist, Rali Bozinhova.

“Telogen Effluvium and Chronic Telogen Effluvium can both present on their own or simultaneously alongside genetic hair loss, making any existing shedding seem worse than before. However, while Male and Female Pattern Baldness only affect the top of the scalp from crown to hairline and temple areas, Telogen Effluvium causes shedding from the entire scalp.

We advise anyone experiencing unusual levels of hair fall, persistent or sudden shedding to visit a dedicated hair loss clinic for a specialist consultation. That way a professional can assess your scalp and provide you with not only a diagnosis, but also personalised hair loss treatment recommendations, based on their findings and your medical profile.”

Hair regrowth options

In the majority of cases, the following timelines will see natural hair growth resume: up to 6 months for Telogen Effluvium, 6-12 months for Chronic Telogen Effluvium and around 12 months from the last chemotherapy session for chemo-induced Anagen Effluvium.

For those wanting to help accelerate their hair regrowth, Telogen Effluvium treatment courses are available for both the regular and chronic forms, depending on medical suitability.

When the does hair grow back, in some cases – typically following cancer treatment or Alopecia Areata – as was the case for Sarah Hyland, the hair may be a different colour or texture.

This tends to be a temporary issue which resolves itself within a full hair cycle or two, but it can cause changes to hair pigmentation, with it often appearing paler than before, or can leave previously straight hair, curly.

It is normal for this to happen and is not something to worry about unduly, however, if you are particularly concerned, an assessment and advice from a hair loss specialist should put your mind at rest.


Circ - Belgravia Centre Hair Loss Clinics LondonThe Belgravia Centre

The Belgravia Centre is an organisation specialising in hair growth and hair loss prevention with two clinics and in-house pharmacies in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. View our Hair Loss Success Stories, which includes the world’s largest gallery of hair growth comparison photos and demonstrates the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time to arrange a free consultation.

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HairlossANSWERS - Click to Submit Your Query to Our Hair Loss Experts

Name: Micah

Question: I need to buy travel insurance but I’m not sure if I have to disclose my hair loss on the list of existing health conditions, can you help?

Answer: Hi, Micah. This is really a question for the travel insurance company as each insurer is likely to have their own set of rules regarding which medical conditions must be disclosed.

As such, we would highly recommend checking with your potential insurance providers first so that you can be certain of having the correct information.

vacation summer holiday travel swimming

However, as a general rule,
for the purposes of travel insurance ‘pre-existing medical conditions’ declarations, hair loss is not widely considered a ‘health issue’ nor an existing medical condition.

This is the case for the majority of hair loss conditions, especially Male Pattern Baldness, Female Pattern Hair Loss, Alopecia Areata and Traction Alopecia as the insurance industry largely classes these issues as ‘cosmetic’.

You don’t mention the cause of your shedding but if the hair loss is the result of an illness or medical treatment, for instance cancer and chemotherapy or radiotherapy, or Telogen Effluvium due to, for example, an underlying thyroid problem, it is the health condition that should be listed on the form, rather than the hair loss it causes as a side effect.

Reputable UK consumer rights organisation, Which? published an article on 13th May 2019 about this subject which you may find interesting. It lists the pre-existing medical conditions that must be declared when purchasing travel insurance. As per our advice above, it does also caution that the buyer should always check with their individual insurer before buying, in order to ensure they have provided the correct information necessary to validate their cover.

The key conditions Which? listed, as provided by Medical Travel Compared, are as follows and generally apply if they have been present within the past two years:

  • Type 2 Diabetes
  • Diagnosed complications with a current pregnancy
  • Epilepsy
  • Asthma – current or any historic cases
  • Parkinson’s Disease
  • Arthritis
  • High blood pressure – current or any historic cases
  • Post traumatic stress disorder (PTSD) or depression
  • Irritable Bowel Disease (IBD)
  • Cancer – current or any historic cases

We hope this information is helpful; have a great holiday!


The Belgravia Centre

The Belgravia Centre is an organisation specialising in hair growth and hair loss prevention with two clinics and in-house pharmacies in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. View our Hair Loss Success Stories, which includes the world’s largest gallery of hair growth comparison photos and demonstrates the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time to arrange a free consultation.

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A clinical trial being carried out by researchers at the University of Minnesota Clinical and Translational Science Institute, USA, which started in January 2016, has now confirmed a completion date of 30th May 2019.

The trial is investigating neurogenic inflammation and the use of topical 6% gabapentin therapy as a treatment in cases of symptomatic scarring alopecia, also known as cicatricial alopecia.

This group of conditions, which can be painful and generally cause permanent hair loss, includes a number of individually established concerns, such as Frontal Fibrosing Alopecia (FFA), Lichen Planopilaris (LP), and Central Centrifugal Alopecia (CCA).

dropper medicine liquid

Small scale pilot cohort study

The cohort study is small in scale, featuring a total of ten participants – both men and women aged 18 years or over – with biopsy-confirmed diagnoses of cicatricial alopecia.

Each volunteer has at least one persistent scalp symptom, besides hair loss, that is associated with inflammation, for instance pain, burning, itching, a tingling or crawling sensation, stinging or tenderness.

They are being administered 1ml of a topical 6% gabapentin solution twice per day for duration of the 12 week pilot study.

Gabapentin is an anti-convulsant prescription medication used for epilepsy, nerve pain and, occasionally, for migraines. It is currently available for these purposes under the Pfizer brand name of Neurontin in the UK.

Researchers from the University explained why they chose to explore gabapentin as a potential treatment for scarring alopecia in the trial registration information.

“There has been no study of topical neurogenic agents, such as gabapentin, to treat scarring alopecia. However topical gabapentin has been safely used in other conditions associated with chronic pain, burning, irritation, itch, or tingling, such as vulvodynia,” it states.

“This study will serve as a pilot study to determine the efficacy and safety of topical gabapentin in the treatment of symptomatic scarring alopecia. In this study, 10 subjects with symptomatic lymphocytic-type scarring alopecia will be recruited and treated with topical gabapentin. Disease burden will be evaluated before and after 12 weeks of treatment through reporting of subjective symptomatology via surveys/questionnaire, neurometer study, clinical assessment, and biopsies measuring levels of CGRP before and after treatment.”

Treating scarring alopecia hair loss

Whilst there are medications available to help manage symptoms, such as the inflammation associated with cicatrical alopecias, there are currently no established hair loss solutions for these conditions.

Although Central Centrifugal Alopecia treatment – also known as Follicular Degeneration Syndrome – is sometimes possible, depending on the extent of its progression, the resulting baldness these hair loss conditions cause is often permanent.

Although in some instances a hair transplant may be possible, this is decided on a case by case basis as there are many factors involved in deciding whether or not someone is suitable for surgical hair restoration.

It is also vital that anyone considering this type of procedure visits surgeons who are skilled and experienced in this particular type of operation as it should be carried out by a specialist in the field.

At present, there are a number of studies into scarring alopecia and its various phenotypes, as well as research underway into various potential treatments to help those affected regrow hair. These include exploration of fractionated CO2 laser therapy and the analgesic drug apremilast.

For now, however, anyone concerned about scarring hairloss should consult their GP as a first port of call.


Circ - Belgravia Centre Hair Loss Clinics LondonThe Belgravia Centre

The Belgravia Centre is an organisation specialising in hair growth and hair loss prevention with two clinics and in-house pharmacies in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. View our Hair Loss Success Stories, which includes the world’s largest gallery of hair growth comparison photos and demonstrates the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time to arrange a free consultation.

Related Stories


Given the many, complex genetics and external factors involved in hair loss, researchers are always on the look out for new ways to approach the problem.

By identifying new targets, innovative approaches can be developed, which may, in turn, lead to novel treatment solutions being established, as has been the case with JAK inhibitors.

HMBG1 protein

An article published in the Nature Journal Scientific Reports on 30th April 2019 points to an inflammatory mediator – the high-mobility group box 1 (HMGB1) protein – as a potential hair growth influencer, worthy of further exploration.

Trauma-induced hair growth

The starting point for a team of researchers from the Department of Dermatology and Cutaneous Biology Research Institute at Yonsei University College of Medicine, and the New Hair Institute, both based in Seoul, Korea, was the unexpected hair growth which can occur following a tissue injury.

Although the reason for this spontaneous hair growth is unknown, the team believed it was “likely related to inflammatory mediators”, specifically, HMBG1.

They describe HMBG1 as “a ubiquitous nuclear protein that is released from cell nuclei after tissue damage”, and carried out a number of experiments in order to establish its effects on hair shaft elongation (hair growth) and on mRNA and protein expression in cultured human dermal papilla cells (hDPCs).

The results showed that HMBG1 did indeed promote hair growth in an ex vivo hair organ culture, as well as producing “significantly increased” mRNA and protein expression levels of prostagladin E synthases.

Additionally, HMGB1 was found to both stimulate secretion of the
inflammation supressant prostaglandin E2 (PGE2) from hDPCs and block a canonical HMBG1 receptor.

What this essentially means is that HMBG1 can actively promote hair growth via PGE2 secretions from hDPCs.

“This mechanism can explain the paradoxical phenomenon of trauma-induced hair growth. Thus, HGMB1 can be a viable therapeutic target for the treatment of alopecia,” concludes the Korean research team.

Treating different types of hair loss

One key piece of information missing from this new research is the hair loss condition HGMB1 may potentially be developed into a treatment for. As the report simply uses the catch-all medical term for any kind of hairloss – ‘alopecia’ – it may be that this is still to be determined.

hair loss treatments and hair growth supporting products for men and women

Currently there are MHRA-licensed and FDA-approved hair loss treatments available for Male Pattern Baldness and Female Pattern Hair Loss, as well as FDA-cleared hair growth devices which can be used alone or alongside these authorised medications.

One of these two drugs – high strength minoxidil, a topical vasodilator which is used to promote hair growth – has also been shown to have additional applications outside genetic hair loss, having produced significant regrowth results in cases of Alopecia Areata, Traction Alopecia and various temporary hair loss conditions, such as Telogen Effluvium.

Anyone worried they are losing more hair than normal, or experiencing sudden shedding, should consult a specialist as soon as possible in order to receive a professional diagnosis of the issue alongside personalised treatment recommendations, including non-pharmaceutical hair growth supporting products that may be beneficial, based on the findings of a dedicated hair loss specialist.


The Belgravia Centre

The Belgravia Centre is an organisation specialising in hair growth and hair loss prevention with two clinics and in-house pharmacies in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. View our Hair Loss Success Stories, which includes the world’s largest gallery of hair growth comparison photos and demonstrates the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time to arrange a free consultation.

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A small-scale clinical trial investigating the potential use of cyclosporin as a treatment for moderate to severe forms of Alopecia Areata has produced fairly disappointing results.

The immunosuppressant drug, also known as cyclosporine or cyclosporine A and commonly used to treat rheumatoid arthritis, Crohn’s disease or given to organ transplant patients to help prevent rejection, previously showed promise as a potential hair loss solution in a 2018 trial, when it was used in a shampoo format.

Cyclosporin - cyclosporine - ciclosporin

Authors of this new study, carried out in Melbourne, Australia, state in their published findings, however, that the response “approached but did not reach a statistically significant difference between cyclosporin and placebo.”

Further tests may be warranted

Alopecia Areata is an autoimmune disorder which causes the body to attack its own hair follicles, resulting in sudden hair loss. This ranges in severity depending on the phenotype, from the scalp-only form which presents as bald spots or patches (Alopecia Areata), to complete hairloss of the head (Alopecia Totalis) or from head-to-toe (Alopecia Universalis).

Given cyclosporin dampens the immune system and is currently used to treat other autoimmune diseases, it seems a clear candidate for an Alopecia Areata trial.

This three month trial comprised 32 participants aged between 18 and 65 years, with a diagnosis of Alopecia Areata, Totalis or Universalis. The mean candidate age was 41 years old and it was mostly women who took part.

Half of the group were given 4mg of cyclosporin per kg of their body weight per day and the other half were given matching amounts of a placebo.

The cyclosporin group had a greater proportion of participants achieving at least a 50% reduction of SALT score (31.3% versus 6.3%; p=0.07) and greater proportion of participants achieving a 1 grade improvement in eyelash (18.8% versus 0%; p=0.07) and eyebrow (31.3% versus 0%; p=0.02) scales compared to placebo,” confirms the Australian team.

Therefore, at the end of the three months, results between the two arms
– measured by a number of methods including SALT score, quality of life questionnaires, blood work, photography and assessments of eyebrows and lashes – were not considered statistically significant.

Given the short timeline and small number of participants, it may be the case that further, wider-ranging clinical trials, perhaps with more subjects, testing various timelines and dosages may be considered in the future.

grapefruit

Test subjects should avoid grapefruit

Often there are certain contraindications for medications – things that should be avoided as they have been shown not interact well with the prescribed drug. In the case of cyclosporin there is something of a quirky requirement – that patients taking it avoid eating grapefruits or drinking grapefruit juice.

The British Association of Dermatologists states that cyclosporine users should avoid consuming grapefruit whilst on this medication as it “may alter the metabolism of the drug“. This may, in turn, lead to an increased propensity to side effects.

Until a medical regulatory body-authorised Alopecia Areata treatment option is discovered, anyone worried about sudden hair loss should speak to a professional as soon as possible for advice on dealing with alopecia.

For adults where only the scalp is affected, a hair loss specialist may be consulted, and for adults losing hair from their face and/or body as well as their scalp, it is best to go to your GP or dermatologist for treatment advice. This is also the case for children under 16.


Circ - Belgravia Centre Hair Loss Clinics LondonThe Belgravia Centre

The Belgravia Centre is an organisation specialising in hair growth and hair loss prevention with two clinics and in-house pharmacies in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. View our Hair Loss Success Stories, which includes the world’s largest gallery of hair growth comparison photos and demonstrates the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time to arrange a free consultation.

Related Stories


The findings from a small scale clinical trial into whether injections of abatacept may effectively treat moderate to severe Alopecia Areata have now been published.

Although the trial was initially thought to be exploring abatacept in relation to Alopecia Areata of the scalp, through to Alopecia Totalis and Alopecia Universalis – the more severe forms which also cause hair loss of the head and body – this confirms that it concentrated solely on the scalp-only form.

Columbia University Department of Dermatology’s Clinical Research Unit, New York, in collaboration with the biopharmaceutical company Bristol-Myers Squibb updated the trial registration with these results on 17th April 2019.

Self-administered injections

The open label trial involved 15 participants with Alopecia Areata – 9 females and 6 males, all between 21 and 62 years old, with a mean age of 39. Of the 15 who started the trial, 14 completed the study with one withdrawing for reasons not stated in the documentation.

Each volunteer self-administered injections of 125mg abatacept each week for 6 months in order to determine the short-term efficacy and safety of the potential treatment. The responders were then followed for a further six months once they had stopped using abatacept.

The primary aim of the Columbia trial was to gauge how well the participants tolerated the abatacept as well as the hair regrowth they experienced that could be attributed to the drug.

Some hair regrowth observed

Studying hair regrowth in relation to the patchy hair loss of the scalp caused by Alopecia Areata can be tricky given this particular form of autoimmune alopecia is prone to spontaneous remission. In many cases, the hair grows back naturally within 12 months, though if or when it may do so cannot be predicted. This makes it difficult for researchers to know what is natural hair growth and which results are directly attributable to treatment.

In order to address this issue, researchers established the following protocols: “The study’s primary efficacy endpoint will be the proportion of responders after 6 months of treatment, with response defined as 50% of greatr hair re-growth from baseline as assessed by Severity of Alopecia Tool (SALT) score at week 24. This is a relatively strict definition for defining responders and non-responders and was chosen to minimize the potential for spontaneous remission, in which fewer than 10% are expected to achieve this magnitude of hair regrowth spontaneously.”

Of the 15 patients analyzed – one of whom later dropped out – the mean SALT scores were recorded as follows, with a standard deviation of 3.8 for all readings:

  • 4.2 – Week 0 (Baseline)
  • 3.9 – Week 12
  • 4.6 – Week 24

No serious adverse effects were noted in any of the test subjects, however, six reported upper respiratory infection symptoms, one experienced a recurrent yeast infection and three had side effects including body aches, tightness at the injection site and tingling of the hands or arms.

The trial documentation does not state whereabouts the injections were administered to, though usually where subcutaneous treatments for hair loss are involved, they are injected directly into the scalp. In this case, as it mentions hands and arms in relation to ‘site injection’ adverse effects, it may be that the injections were administered to the arm.

Current Alopecia Areata Treatment options

As before, in many cases hair growth will resume naturally, usually within 12 months of the first bald spot appearing, but this is not always the case.

As the British Association of Dermatologists advises, “Depending on the extent of hair loss there is a good chance that, for 4 out of 5 affected people, complete regrowth will occur within 1 year without treatment. There may, however, be further episodes of hair loss in the future. If there is very extensive hair loss from the start, the chances of it regrowing are not as good. Those with more than half the hair lost at the beginning or with complete hair loss at any stage have only about a 1 in 10 chance of full recovery. The chances of regrowth are not so good in young children and those with the condition affecting the hairline at the front, side or back.Continues below…

For those wishing to explore hair loss solutions to help their regrowth along, there are already a number of Alopecia Areata treatment options available, especially for adults, where the scalp-only phenotype is concerned.

These range from topical applications of high strength minoxidil – a medication which promotes hair growth and is currently both MHRA-licensed and FDA-approved for the treatment of genetic hair loss – to more invasive approaches, such as steroid injections.

Adults wishing to investigate the best options for their condition are advised to consult a hair loss specialist or dermatologist, whilst those with children aged 15 or under should speak to their GP as a first port of call.


The Belgravia Centre

The Belgravia Centre is an organisation specialising in hair growth and hair loss prevention with two clinics and in-house pharmacies in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. View our Hair Loss Success Stories, which includes the world’s largest gallery of hair growth comparison photos and demonstrates the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time to arrange a free consultation.

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A study published in the Journal of the American Academy of Dermatology has found that it’s not just children with Alopecia Areata who are emotionally affected by the condition; their parents or guardians can also experience negative effects to their quality of life.

This latest research backs previous 2018 findings which led for a call for more psychodermatology counselling to be made available to children and their caregivers following an Alopecia Areata diagnosis, regardless of its severity.

Alopecia Areata is an autoimmune disease which has three main phenotypes; Alopecia Areata (the phenotype, though also – somewhat confusingly – the overarching name for the condition in all its iterations) causes patchy hair loss of the scalp only, whilst Alopecia Totalis and Alopecia Universalis lead to total baldness of the head and from head-to-toe, respectively.

In many cases, where the condition affects the scalp only, natural hair regrowth will occur within 12 months. However, this is not always the case and whether or not it may happen is impossible to predict. Furthermore, even if the hair regrows, Alopecia Areata relapses may present in the future.

Effect of Alopecia Areata on care-givers

As sudden hair loss is symptomatic in all cases, this – in addition to the uncertainty element – can make the condition particularly hard to deal with, both for those going through it and for those caring for them who can do little more than provide moral support.

Researchers from The Children’s Hospital of Philadelphia, Pennsylvania, USA, carried out a prospective, cross-sectional study to ascertain any potential relationship between care-givers’ quality of life (QoL) and the child’s age, severity of Alopecia Areata and its duration.

Of 153 paediatric patients studied, significant ‘mild-to-moderate’ links were found between the parents’ quality of life and how extensive their child’s hair loss was, based on scores using the Severity of Alopecia Tool (SALT). Whilst there were also negative correlations seen between parents’ QoL and the age of the child, the duration of the condition did not appear to have any impact.

The study authors conclude, “Impaired parent QoL might be associated with increasing severity of disease and age of affected child but not duration of disease. Providers should tailor counselling accordingly and help parents set realistic expectations for long-term experience with the disease.”

Sources of support

Alopecia Areata treatment is possible for the scalp-only phenotype, though generally only for those aged 16 and over. For children and young adults in the UK wishing to try wigs due to medical hair loss, these are available free of charge from charities the Little Princess Trust and Hero by LPT.

Any parents of children with Alopecia Areata can speak to their GP or dermatologist for advice on coping and how best to support them, as well as how to look after their own mental health. Hair loss charities such as Alopecia UK are also an invaluable source of peer support which can help those affected, either directly or indirectly, feel less alone.


Circ - Belgravia Centre Hair Loss Clinics LondonThe Belgravia Centre

The Belgravia Centre is an organisation specialising in hair growth and hair loss prevention with two clinics and in-house pharmacies in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. View our Hair Loss Success Stories, which includes the world’s largest gallery of hair growth comparison photos and demonstrates the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time to arrange a free consultation.

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